Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.00 / $106.25 / $313.52	Facility	26	$85.00	$106.25	$313.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $209.68 / $425.00 / $1,122.50	Professional		$209.68	$425.00	$1,122.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.84 / $123.16 / $322.00	Professional	26	$67.84	$123.16	$322.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.57 / $340.00 / $724.19	Professional	TC	$147.57	$340.00	$724.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.74 / $167.70 / $289.48	Professional		$126.74	$167.70	$289.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.97 / $95.47 / $125.95	Professional	26	$55.97	$95.47	$125.95
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $104.00 / $104.00 / $109.80	Professional	TC	$104.00	$104.00	$109.80
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $188.36 / $365.69 / $783.67	Professional		$188.36	$365.69	$783.67
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.59 / $99.60 / $193.55	Professional	26	$67.59	$99.60	$193.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.33 / $206.97 / $643.44	Professional	TC	$121.33	$206.97	$643.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $71.59 / $148.83 / $241.20	Professional		$71.59	$148.83	$241.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $221.99 / $532.66 / $1,056.55	Professional		$221.99	$532.66	$1,056.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.81 / $122.25 / $208.20	Professional	26	$71.81	$122.25	$208.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $146.22 / $374.10 / $837.17	Professional	TC	$146.22	$374.10	$837.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $206.68 / $375.78 / $1,489.62	Professional		$206.68	$375.78	$1,489.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.62 / $118.96 / $260.68	Professional	26	$74.62	$118.96	$260.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $132.06 / $240.10 / $1,320.03	Professional	TC	$132.06	$240.10	$1,320.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $96.74 / $182.66 / $347.60	Professional		$96.74	$182.66	$347.60
United Facility/Professional Professional Modifier Low / Median / High Price $209.48 / $383.88 / $885.06	Professional		$209.48	$383.88	$885.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.77 / $98.85 / $167.47	Professional	26	$70.77	$98.85	$167.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $137.18 / $251.89 / $595.10	Professional	TC	$137.18	$251.89	$595.10